PatientTreatment

Eye Care

Several serious eye conditions do not have any apparent early warning systems. Therefore a regular eye check is of immense benefit in the maintenance of proper eye health and forewarning of possible dangers. If any person is apprehensive about his or her eyesight, seeking specialist care is recommended.

Eye problems or injuries can occur suddenly. If one experiences eye pain, loss of sight or apparently sees "flashing lights", you should see your doctor or the local accident/emergency department without delay.

Anatomy of the Eye

Although it is small in size, the eye arguably provides us with the most important of the five senses - vision. This section gives a short overview of the anatomy of the eye and how it works.

Vision occurs when light enters the eye through the pupil. With help from other important structures in the eye, like the iris and cornea, the appropriate amount of light is directed towards the lens.

Just like a lens in a camera that sends a message to produce a film, the lens in the eye 'refracts' (bends) incoming light onto the retina. The retina is made up by millions of specialised cells known as rods and cones. These work together to transform the image into electrical energy and this is sent to the optic disc on the retina and transferred via electrical impulses along the optic nerve to be processed by the brain.

1 The cornea is the clear surface of the outer eye which can be damaged by infections

2 The iris gives the eye colour. The pupil is the opening within the iris. Contraction of the iris makes the pupil small, relaxing of the iris makes the pupil large.

3 The pupil is the black opening within the iris that lets light into the eye. It changes size in response to light levels, among other things.

4 The lens is the internal focusing element of the eye and it is curved on both sides. The clear lens becomes cloudy when a cataract forms.

5 The conjunctiva is the thin lining of the inside of the eyelid. It extends over the front of the white part of the eye.

6 The retina is the light sensitive part of the eye. Retinitis Pigmentosa - RP - is a progressive disease which gradually destroys the retinal cells.

7 The optic nerve In glaucoma is damaged when the fluid pressure in the eye increases and cause pressure on the nerve fibres entering the optic nerve from the retina.

Common Eye Condition

A few common eye conditions are detailed below. You may visit our useful website section for details on other eye diseases.

Cataracts

Glaucoma

Squint

Diabetic Retinopathy

Age-related macular degeneration (AMD)

Posterior vitreous detachment (PVD)

Charles Bonnet syndrome

Retinal detachment

Coloboma

Uveitis

Giant Cell or Temporal Arteritis

CATARACTS

Many Sri Lankans above the age of 50 suffer from a condition called Senile Cataract, which causes blurred vision. There are several other types of cataracts. Congenital Cataracts - where persons are born with a cataract. Diabetic Cataracts - form in persons with Diabetes. Traumatic Cataracts - can result due to an injury to the eye. Secondary Cataracts - are due to the patient contracting other general body or eye diseases. In all instances, a person with a cataract starts to experience blurred vision and sometimes multiple images. They could also suffer from poor vision even in brightly lit surroundings and may require regular changes to their prescription spectacles.

Cataracts cannot be removed by the use of medicines. It requires surgery. However surgical methods have vastly improved and today the patient is not even required to stay overnight in the hospital. In surgery, the affected lens is removed and a permanent artificial lens is implanted. In some instances a mild prescription spectacle needs to be used by the patient after surgery. Cataract can be easily detected. Elderly patients are advised to have regular eye checks to detect of the early stage cataracts.

GLAUCOMA

In our eye there's a fluid called aqueous humor which is continuously produced, there by maintaining a constant pressure in the eye. If there is an imbalance in the production and drainage of this fluid, the pressure in the eye rises, causing the condition Glaucoma (increased intraocular pressure)

In open angle glaucoma usually there're no symptoms and is detected during routine eye examinations (probably while checking for reading glasses). Sometimes in advanced cases it is detected later when certain vision loss has occurred.
In closed angle glaucoma there will be pain and redness in the eye with visual disturbances.

There's no permanent cure for glaucoma. Treatment only keeps the condition under control. Open angle glaucoma is effectively treated with medicines usually in the form of eye drops.
Some people may eventually need surgery if the medicine doesn't control it.
It is important to understand the condition and the treatment the doctor prescribed to prevent blindness, and control of the condition is greatly dependent on faithfully following the treatment instructions.

SQUINT

Squinting of the eyes explained simply means that the muscles that move the two eyes are not acting in a well-coordinated manner as is the case in eyes without squints. There are broadly two types of squints i.e. obvious squints and hidden squints which can be detected only by special tests. Squints are frequently seen in children but maybe seen in older people as well. In children squints can lead to reduced vision in one or both eyes and hence it is important that the child is seen as early as possible even if the child is only a few months old so that corrective steps can be taken to ensure that loss of sight is prevented. A sudden onset squint at whatever age may indicate serious brain or eye problems and must be shown to a doctor immediately.

DIABETIC RETINOPATHY

In diabetic patients one of the serious complications is the development of eye disease which is referred to as diabetic retinopathy. Due to the presence of excessive amounts of sugar in the blood, changes occur in the inner layers of the eyes which may be similar to the changes occurring in the kidneys and other organs as well. The changes occurring in the minute blood vessels in the eyes can cause swelling and bleeding into the back of the eye with subsequent loss of sight. On first detection of diabetes it is important that the eyes too are checked at the same time so that the presence of any early blood vessel changes can be noted and recorded to facilitate follow up. If the diabetes has gone undetected for a while, the eyes may show changes that need urgent treatment to prevent rapid loss of sight. This usually involves a process of heat sealing of blood vessels using laser heat or the retinopathy may be so advanced as to require major surgery even at the time of the first examination.

CONJUNCTIVITIS

This is the name given for the condition which causes the outermost coat of the eye (the conjunctiva) to become inflamed. This will cause the patient to feel grittiness, itching and watering from one or both eyes. The eye appears red and frequently but not always there is a sticky discharge as well. While this condition may settle on its own or with the use of an antibiotic it is important that the patient is seen by a doctor so that more dangerous conditions that give similar symptoms are not left untreated.

BLEPHARIITIS

This refers to a common condition which results in inflamed lid margins. Patients frequently present with itchy eye lids which can be sore and red. There may also be dandruff like material at the roots of the eye lashes. The diagnosis is usually easily made by a doctor who will recommend lid hygiene and occasionally prescribe an ointment and artificial tears depending on the associated signs and symptoms.

RETINAL DETACHMENT

The retina is the innermost layer of the eye and one of the most important structures concerned with sight. It resembles a fine sheet of transparent material and is usually well attached to the underlying structures of the eye. In some instances especially in short sighted persons or those who have undergone previous eye surgery or suffered eye injuries, this transparent sheet gets lifted off the underlying structures and the condition is referred to as a retinal detachment. A person with a detachment may experience flashing lights, or a sensation of floating particles within the eye a few days or weeks prior to the actual detachment. When a detachment actually occurs there may be a sensation of having a water bubble in the eye that is blocking sight or there may be a sudden dramatic reduction in sight described as a curtain falling in front of the eye. Treatment for the symptoms of flashes and floaters must be sought urgently and timely intervention may prevent the need for major surgery.

CORNEAL ULCER

The cornea is the outermost transparent layer of the eye which resembles a clear glass window. An ulcer which refers to a wound, may form on the cornea even after trivial injury especially in diabetics and those wearing contact lenses or if the injury involves any contamination with plant leaves, dirt, stones etc which is frequently the case. A corneal ulcer causes redness, pain, watering and frequently a reduction in sight. There may be a visible white spot on the eye as the disease progresses. Since a corneal ulcer can progress very rapidly and even cause the eye to fill with pus and burst, treatment needs to be started urgently and the patient may even need to be admitted to the hospital for frequent instillation of drops and careful monitoring.

UVEITIS

The uvea is the middle coat of the eye that includes the coloured part of the eye known as the iris. In uveitits it is this layer of the eye that gets inflamed and sticky and can vary from being a mild inflammation of the front of the eye (anterior uveitis) to being a severe sight threatening inflammation involving the entire middle coat up to the back of the eye (pan uveitis) . The symptoms may vary from mild redness, pain, watering and blurring of sight to severe pain and redness with a significant reduction of sight. In a large number of patients it is not possible to detect any underlying reason for the uveitis to occur but in a significant number of patients it may be a manifestation of an underlying disease involving the rest of the body. Uveitis has a tendency to recur even after being completely treated and especially if recurrences occur, tests need to be carried out to assess if there is an underlying disease of the rest of the body. Treatment includes frequent instillation of eye drops in the initial stages which may need to be continued for several months under close medical supervision.

Other Eye Conditions

There are many more less common conditions which too can have a debilitating effect on eyes and sight. Following are some such examples.

Aniridia

Bests disease

Laser surgery following cataract operations

Childhood Squint

Coats disease

Congenital cataracts

Corneal dystrophies (including Keratoconus)

Corneal transplantation

Diabetes related eye conditions

Dry eye

Hemianopia

High degree myopia

Light sensitivity

Macular Hole

Nystagmus

Retinitis pigmentosa

Retinal vessel occlusion

Retinopathy of prematurity

Stargardts macular dystrophy

Thyroid eye disease

The Ophthalmic Plastic and Reconstructive Surgery (Oculoplastic) service